The University of Michigan Health System is known internationally for its research on pain, including research about the quality of pain care and its impact on quality of life, imaging that shows what happens in the brain when a person is in pain, early acceptance of and research related to fibromyalgia, and one of the top centers in the world for the study of pelvic and vulvar pain.

After several years of using sophisticated brain-imaging techniques that allow us to see chemical activity in the brain while pain is occurring, U-M researchers believe they've pieced together some clues to individual pain variations and the placebo effect that occurs with many painkillers and other medications. The team has reported that gender, sex hormones like estrogen, and genes appear to play a big part in how an individual's body, and emotions, react to pain. The research suggests that variations in women's estrogen levels -- like those that occur throughout the monthly menstrual cycle, or during pregnancy -- regulate the brain's natural ability to suppress pain. When estrogen levels are high, the brain's natural painkiller system responds more potently when a painful experience occurs, releasing chemicals called endorphins or enkephalins that dampen the pain signals received by the brain. But when estrogen is low, the same system doesn't typically control pain nearly as effectively.

Fibromyalgia often has been misdiagnosed as arthritis or even a psychological issue. Increasingly, though, the scientific knowledge about fibromyalgia is growing, thanks in no small part to the work of U-M researchers. U-M is one of the leaders in fibromyalgia research, with studies showing *overwhelming data* that the condition is real, is characterized by a lower pain threshold and is associated with genetic factors that can make some people more likely to develop fibromyalgia.

Research at U-M about the brain's own pain-fighting chemicals -- endorphins -- shows that they play a role in the phenomenon known as the placebo effect, and that this response corresponds with a reduction in feelings of pain. Studies at U-M also have shown that the brain reacts physically when a person is given a sham pain treatment, which they believe will help them. These studies may help explain why so many people say they get relief from therapies and remedies with no actual physical benefit. In the long run, the research may lead to better use of cognitive, or psychological, therapy for people with chronic pain.

Further research at U-M has shed light on disparities in pain care based upon age, race and gender; variability of health care providers in pain management decision-making; and structural barriers to accessing quality pain care. The research has found that African Americans and women may be disproportionately missing out on effective treatment for their chronic pain and cancer pain -- from arthritis to backaches to cancer -- even though effective treatments are available. As a result women and minorities encounter more adverse effects on their ability to work, play and enjoy life. The researchers also have found that adults under the age of 50 who have chronic pain may be less able to cope with their condition and more prone to associated depression than their elders.

Pain conditions specific to women are the focus of U-M's groundbreaking research about pelvic and vulvar diseases. Researchers have discovered that vulvar pain is typically associated with a greater overall pain sensitivity in women, and that 3 percent of women experience chronic vulvar pain -- thus debunking the earlier belief that the condition is rare.

Michigan researchers are leading the charge to improve the understanding of pain. We are excited about our discoveries and look forward to translating our findings into improvements in the way physicians assess and treat pain, thereby improving the quality of life for millions of Americans living with chronic pain.